Gilead's COO, John Milligan at the recent earnings call said that while immuno-oncology is extremely crowded, he wouldn't rule out an investment in that area if the approach was novel or the benefit to patients great. The PD-1 and PD-L1 inhibitor space is crowded and dominated by Merck, Bristol, and Roche, but CAR-T space is novel but low in buyout price.
Gilead has cash from sales of Harvoni et al.. Celgene's equity position would not prevent Gilead from buying Juno. They could offer 150 dollars per share; 15 B is not too high for Gilead. They paid 11B for one drug, Sovaldi. Potentially, CAR-T offers a lot more.
There should be synergy btw ENaC inhibition and chloride transport enhanced by Kalydeco or by Orkambi. Lung function should improve more as a result.
It does not matter. Gilead has more cash than they know what to do with. Any takeover will be friendly and the Juno board will agree with.
Treatment outcomes for genotype 3 and cirrhotic HCV patients of all genotypes are poor using all-oral drugs or in combination with interferon and rivabirin. If Phase II trial gives the SVR24 of around 95% or so, there is a good chance that the above hard-to-treat groups can benefit from the "sandwich" regimens.
There are more than 7 million HCV patients in major markets (US and EU). 15% of these is cirrhotic. So, there are more than 1 million patients who can benefit from RG-101 + oral drugs in the major markets. Suppose that only 50 K of 1 M (5%) treats a year with this combo, and the drug is priced around 10 K (this is a bargain). This can generate a revenue of 500 M. If this can be achieved, the market cap for Regulus would be around few billions. The share price would be around 70 without the help from other drugs in the pipeline.
Investors are anticipating a very good news from the Ph I trial of ALN-PCSsc. If the news and morning CC tomorrow announce a reduction of LDL-c is around 60%, MDCO may jump to 40 or above provided there is no safety issue. Regeneron and Amgen have mAb version of inhibitors to PCSK9. Absence or loss-of-function mutation of this gene PCSK9 have been shown to reduce the risk of cardiovascular events.
The total ion concentration in the water layer on the airways lining determines the water volume. If the ions flow out into the lining interface water, the airways will be hydrated and the lung will be happy. But if the ions are excessively moved into the tissue from the interface water volume, the airways will be dehydrated and the lung will be unhappy. Remember water always follow the ions. In CF lungs chloride ions don't flow out actively into the interface water volume. Positive ions such as sodium ions cannot diffuse out into the interface water because they follow anions such as chloride ions. On top of that, in CF lungs the active Na+ ion pumping by ENaC removes Na ions out of the interface volume. Both sodium and chloride ions are kept away from the interface. The net result is that the interface will lack both ions and water. Immune cells in the interface will be very unhappy and cannot remove bacteria in it.
Now Orkambi partially restores chloride pumping into the interface, and an ENaC inhibitor would block sodium pumping out of the interface. So, plenty of both ions will be there and water volume will increase. I hope this answers your question.
The VRTX target share price was raised earlier to $160 from 130 at Robert W. Baird, also to $161 from $146 at Piper Jaffray.
We'll get there one way or another. There might be a surprise at the earnings' conf call.
A portion of an abstract of an article in the September issue of J. Clin. Virology:
"--- People who inject drugs (PWID) are the most important risk group for incident Hepatitis C virus (HCV) infection. In PWID in Europe HCV genotype 3a is highly prevalent. Unfortunately, many of the recently developed directly acting antiviral drugs against HCV (DAAs) are suboptimal for treatment of this genotype. Detection of resistance-associated variants (RAV) in genotype 3a may help to optimize treatment decisions, however, robust protocols for amplification and sequencing of HCV NS5A as an important target for treatment of genotype 3a are currently lacking. ---"
Boulder, CO-based N30 Pharma debuts as Nivalis Therapeutics tomorrow with its IPO. Its lead product candidate is N91115, a small molecule that addresses a defect in CFTR, the underlying cause of CF. N91115 modulates CFTR activity through a novel mechanism of action that stabilizes CFTR inside the cell and at the cell surface. An added benefit is that N91115 is expected to be complementary to existing and future CFTR modulators. A Phase 1b trial is close to completion. A Phase 2 will follow that will evaluate N91115 in a triple therapy with two other CFTR modulators: lumacaftor (Vertex Pharmaceuticals' (NASDAQ:VRTX) investigational VX-809) with ivacaftor (Vertex's Kalydeco) or lumacaftor/ivacaftor (Vertex's Orkambi).
It is interesting to learn that Vertex chose Parion, not Nivalis for financial help.
The Clinicaltrial website gives for the approximate data collection date to be May of 2016.
Both efficacy and safety for homozygous 508 mutation would be as good as, or better than, Orkambi, and the efficacy for heterozygotes with 508 in one allele and Ivacaftor-responsive mutation on the other allele will be better than Ivacaftor alone. I am expecting for the latter a 3-4% FEV1 increase over that of Ivacaftor monotherapy. This is something one should look forward to.
Try to read and understand the data coming out of clinical trials! Go to the Alnylam website and read about the data for Patisiran (TTR02) for FAP, Revusiran (TTRsc) for FAC and SSA, ALN-AT3 for hemophiliac, ALN-CC5 for PNH, ALN-PCS for hypercholesterolemia, ALN-HBV for Hep B and others. Each one of the above drugs has a block buster potential.
Dr. Alan Carr of Needham would never overstate his case. He attended the ER CC and asked about the injection site reaction and rash observed with Revusiran. Needham sent out a message indicating the following.
Mgmt noted 3 pts discontinued revusiran due to rash in Phase 2 OLE trial. The Phase 3 trial is continuing without notable safety issues. All drugs at Alnylam other than patisiran and revusiran incorporate ESC-GalNAc and are not associated w/injection site reactions.
Several important milestones are expected from clinical programs in 2H15, including initial ALN-PCSsc Phase 1 data in hypercholesterolemia, additional data from patisiran and revusiran Phase 2 OLE trials, initial data
from ALN-AS1 Phase 1/2 trial in porphyria, and additional data from Phase ½ trials of ALN-CC5 in complement-mediated disease and ALN-AT3 in hemophilia.
Needham remains confident in platform and reiterate BUY. They see ample opportunity for upside in 2H15.
If you listened to the CC, you’ll find that only 3 out of 25 who received relatively longer term had rash. The rash disappeared spontaneously upon discontinuation without intervention.
There is a good reason to believe that the effect of two drugs in combo is the sum of effects of each type (logarithmically additive synergy). Oral drugs such as Sovaldi, Olysio, or Daklinza can reduce the viral count by a factor of 100,000; they individually kill 99999 out of 100K HCV RNA. A single shot of 2mg RG-101 degrades all but 1 out of 10K HCV RNA. Does this mean that when both are given together the combo can kill all but only 1 out of 1 billion HCV RNA (-5 log + (-4 log) = - 9 log)? This can be true only the two actions are completely independent; RNA that survives an oral drug has the 1 in 10K chance to survive RG-101. If there is an overlap between the two mechanisms of killing, then the effect is less than the direct sum of the parts. All of all-oral drugs inhibits HCV RNA synthesis in hepatocytes. If the mode of action by RG-101 were the same action of inhibiting RNA synthesis, the effect of the combo is less than the sum of the effects of two individually.
Sarnow who had discovered that miR-122 is essential for the survival HCV in the body found more recently that miR-122 protects HCV RNA from degradation by abundant exoribornase XRN2. The normal function of miR-122 is to control lipid metabolism in the liver, but HCV takes advantage of it by binding to it to block XRN2 attack. No evidence exists that shows synthesis inhibition by anti-miR such as RG-101, and all-oral to degrade HCV RNA. These facts suggest the two modes of actions are independent of one another, and the effect will be additive.
I think that the 'sandwich' design of 4 wk dosing will be an overkill.
The bears' case was weak and emotional. The bulls like good science and good medicine.
The combo of oral DAAs with RG-101 will be a huge success. A single RG-101 shot cuts the viral load by 4 log. This reduces the duration of DAA dosing to cure HCV infection regardless of genotypes. DAA combos fail many high viral load, cirrhotic, or co-infected patients. The success rate for the patients with Genotype 3 is as low as 60%. Patients who fail oral DAA treatment has no other recourse but injecting the old Interferon and taking dreadful Ribavirin for 48 weeks minimum.
ALNY was a victim of its own success. ALN-PCSsc is so potent and durable that mAb drugs of REGN and AMGN will become obsolete in several years. REGN fell 23 points today. AMGN fell too. They pushed down IBB. Look at the Charts of REGN and IBB. ALNY is a component of IBB, and often traded like IBB.
Don't worry about the share price. It will more than double next year. Catalysts: ALN-AT3 for hemophilia A and B and RBD, ALN-CCR for PNH, Patisiran, and Revusiran for FAP and FAC. All reporting data this year.
The data of ALN-PCSsc have demonstrated the power of ESC-GalNAc platform.